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227 Cards in this Set
- Front
- Back
1. Institutional care in the past caused what result in patients?
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-Failed to improve
-Developed additional symptoms -Social breakdown syndrome -Extreme withdrawal, anger, and physical aggressiveness -Loss of interest in personal appearance and functioning |
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2. What is Milieu therapy?
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A humanistic approach to institutional treatment based on the belief that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity
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3. What is a token economy program?
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Behavioral program in which a person's desirable behaviors are reinforced systematically throughout the day by the warding of tokens that can be exchanged for goods or privileges
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4. What type of reinforcement is in a token economy program?
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Conditioning Principles
-positively reinforce socially acceptable behaviors -no reinforcement for unsocial behavior |
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5. What are some limitations of token economies?
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1. Studies are uncontrollable (bring whole ward in rather than randomly assign patients to groups)
2. Ethical/legal problems (right to food,storage, space/furniture, movement) 3. Truly effective? (change overt behavior w/o changing psychotic beliefs) |
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6. what are anti psychotic drugs?
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Drugs that help correct grossly confused or distorted thinking
-block excessive activity of dopamine, particularly at D-2 receptors -Produce maximum level improvement w/in first 6 months of treatment |
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7. What are "conventional" anti-psychotic drugs?
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Ones developed throughout the 60's,70's, and 80's
-neuroleptic drugs |
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8. What are "atypical" anti-psychotic drugs?
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New drugs
-"second generation" |
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9. What are neuroleptic drugs?
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Conventional anti-psychotic drugs, so called b/c they often produce undesirable effects similar to the symptoms of neurological disorders
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10. How effective are anti-psychotic drugs?
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-Reduce positive symptoms more than negative ones (especially conventional ones)
-Men respond less readily to drugs than women and require higher doses b/c men tend to have more negative symptoms |
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11. What are extrapyramidal effects?
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Unwanted movements, such as severe shaking, bizarre looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by conventional anti-psychotic drugs
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12. Describe Medication-Induced movement disorders?
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Include:
1. Parkinsonian and related symptoms 2. Neuroleptic Malignant Syndrome 3. Tardive Dyskinesia |
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13. Describe Parkinsonian symptoms?
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-Most common extrapyramidal effect due to reduction of dopamine activity in substantia nigra
-Muscle tremors/rigidity -Dystonia -Akathisia |
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14. What is dystonia?
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Involuntary muscle contractions that produce bizarre movements of the face, neck, tongue, and back
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15. What is akathisia?
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Great restlessness, agitation, and discomfort in the limbs
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16. What is the substania nigra?
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A part of the brain that coordinates movement and posture
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17. What is neuroleptic malignant syndrone?
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A severe, potentially fatal reaction
-affects 1% of patients, particularly elderl |
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18. What are the symptoms of neuroleptic malignant syndrone?
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1. Muscle Rigidity
2.Fever 3. Altered Consciousness 4. Improper functioning of autonomic nervous system |
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19. What is tardive dyskinesia?
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Extrapyramidal effects that appear in some patients after they have taken conventional drugs for some extended period of time (one year)
*affects up to 20% taking drugs *irreversible |
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20. What are the symptoms of tardive dyskensia?
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Involuntary movements usually of mouth, lips, tongue, legs, or body
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30. Why are new drugs called atypical?
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Their biological operation differs from that of the conventional drugs since atypicals are received at fewer D-2 receptors and more at D-1, D-4, and serotonin receptors
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31. What is the effectiveness of atypical drugs?
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85% effective compared to 65% effective conventional drugs
Reduce both positive and negative symptoms |
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32. What are the side effects of the atypical drugs?
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-Produce fewer extrapyramidal side effects (need high dose)
-Don't produce tardive dyskinesia -Risk of agranulocytosis |
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33. What is agranulocytosis?
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A life-threatening reduction in white blood cells
*Sometimes produced by the atypical anti-psychotic Clozapine |
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34. What are relative that display high levels of expressed emotion like?
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Very critical, emotionally overinvolved, and hostile
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35. What are the features of effective community care for treating schizophrenia?
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1. Coordination of patient services (esp for mentally ill chemical abusers, MICA)
2. Avaible short-term hospitalization 3. Partial hospitalization 4. Supervised residencies (milieu philosophy) 5. Occupational training (sheltered workshop) |
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36. How has community treatment failed?
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-40-60% of schizophrenics receive no treatment
-Poor coordination of services -Shortage of services |
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37. What is a case manager?
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A community therapist who offers a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, medication, guidance, and protection of patients' rights
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38. Why is there a shortage of services?
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1. Lack of mental health professionals who wish to work w/ severely disturbed
2. Not in my backyard 3. Funding shortages (primary reason) |
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39. What are the consequences of inadequate community treatment?
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1. 8% enter alternative care facility (nursing home)
2. 18% in privately run residences w/ untrained individuals 3. 31% in rundown occupancy hotel 4. Majority are homeless (1/3 of homeless have severe mental disorder) |
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41. What is a personality?
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Enduring patterns of perceiving, relating to, and thinking about the environment and oneself
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42. What are personality traits?
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How we react in our own predictable and consistent ways
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43. What is the five-factor model of personality?
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1. Open to experience
2. Conscientious 3. Extroversion 4. Agreeable 5. Neuroticism |
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44. What does it mean to be open to experience?
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Proactive seeking and appreciation of experience for its own sake
Toleration for and exploration of the unfamiliar |
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45. What does conscientiousness mean?
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Individual's degree of organization
Contrasts dependable, fastidious people with those who are lackadaisical and sloppy |
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46. What does extroversion imply?
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Frequency and intensity of interpersonal interaction, activity level, need for stimulation, and capacity for joy
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47. What is meant by agreeableness?
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Quality of one's interpersonal orientation along a continuum from compassion to antagonism in thoughts, feelings, and actions
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48. What is meant by neuroticism?
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Proneness to psychological distress, unrealistic ideas, excessive cravings or urges, and maladaptive coping responses
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49. How does this five-factor model of personality relate to personality disorders?
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Majority of personality disorders are characterized by high levels of neuroticism and low levels of agreeableness
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50. What do people with schizoid, schizotypal, and avoidant personality portray low levels of?
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Low levels of extroversion
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51. What do persons suffering from histrionic and narcissistic personality disorders exhibit?
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High levels of extroversion
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52. What is a personality disorder?
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A very rigid pattern of inner experience and outward behavior that differs from the expectations of one's culture and leads to dysfunctioning
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53. What are three characteristics of personality disorders?
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1. Longstanding
2. Inflexible 3. Maladaptive |
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54. What is required according to the DSM-IV?
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1. Deviates from cultural expectations w/ at least two of the following areas affected
2. Pervasive and inflexible 3. Onset in adolescence or early adulthood and pattern is stable/enduring 4. Leads to distress or impairment |
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55. In what areas do personality disorders manifest in (at least 2)?
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Affect
Cognition Impulsive Control Interpersonal Functioning |
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56. What is comorbidity?
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The occurrence of two or more disorders in the same person
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57. What do people with personality disorders often also suffer from?
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Acute Axis 1 disorder
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58. What things must be ruled out or are differential diagnosis when it comes to diagnosing a personality disorder?
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NOT DUE TO:
1. Another mental disorder 2. Medical condition 3. Substance abuse |
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59. What are the three clusters that the DSM-IV separates the 10 personality disorders into?
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1. Odd or Eccentric
2. Dramatic,Emotional,Erratic 3. Anxious or Fearful |
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60. Which disorders are in the "odd or eccentric" cluster?
Three... |
1. Paranoid
2. Schizoid 3. Schizotypal personality |
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61. What are schizophrenia spectrum disorders?
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The odd/eccentric personality disorders that clinicians believe to be related to schizophrenia
-often these people qualify for an additional diagnosis of schizophrenia or have close relatives w/ schizophrenia |
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62. What are characteristics of paranoid personality disorders?
Six symptoms... |
1. Pervasive distrust and suspiciousness of others
2. Shun close relationships 3. Trust own ideas and abilities excessively 4. View other's motives as malevolent 5. Critical of weakness/fault in others but unable to recognize own mistakes 6. Sensitive to criticism |
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63. Do people with paranoid personality disorder have delusional suspicions?
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NO, suspicions are only inaccurate and/or inappropriate
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64. What's treatment like for people w/ paranoid PD?
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-Many view role of patient as inferior and distrust/rebel against therapist
-Therapy is limited and slow -Drug therapy is of limited help |
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65. What is schizoid PD?
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A PD characterized by persistent avoidance of social relationships and little expression of emotion
Also have no social anxiety |
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66. What are some characteristics of schizoid PD?
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-Loners
-Little interest in sex -Indifferent to family -Focus on self -Unaffected by criticism or praise |
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67. What is the treatment for schizoid PD?
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Social withdrawal prevents from entering therapy unless some other disorder makes treatment necessary
-emotionally distant form therapist -don't seem to care about treatment -make limited progress |
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68. What is schizotypal PD?
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A PD characterized by extreme discomfort in close relationships, odd forms of thinking and perceiving, and behavioral eccentricities
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69. What are some characteristics of schizotypal PD?
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-Ideas of reference
-Bodily illusions -Belief in special extrasensory abilities -Belief in having magical control -Difficulty keeping attention focused -Conversation can be digressive and vague |
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70. What are ideas of reference?
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Belief that unrelated events pertain to them in some important way
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71. What are bodily illusions?
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Sensing an external "force" or presence
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72. How is schizotypal PD similiar to schizophrenia?
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-Both have been linked to family conflicts and to psychological disorders in parents
-Linked schizotypal PD to some of the same biological factors found in schizophrenia |
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73. What are the biological factors of schizotypal PD that have been linked to schizophrenia?
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-High activity of dopamine
-Enlarged brain ventricles -Smaller temporal lobes -Loss of gray matter) |
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74. What other disorders has schizotypal PD been linked to?
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-Linked to mood disorders
-Relative of people w/ depression have a higher than usual rate of schizotypal PD and vice versa |
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75. What is the treatment for schizotypal PD?
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Anti-psychotic drugs in low doses appear to help some people
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76. Diagnostic Criteria: Paranoid Personality Disorder
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1. Pervasive distrust & suspiciousness. 4 or more of:
– Suspects without sufficient basis that others are exploiting, harming or deceiving them – Preoccupied with unjustified doubts about loyalty or trustworthiness of others – Reluctant to confide in others because of unwarranted fears… – Reads hidden demeaning or threatening meanings… – Persistently bears grudges – Perceives threats to character or reputation that are not evident to others or quick to react angrily, counterattack – Recurrent suspiciousness with justification re fidelity of spouse or partner 2. Not due to schizophrenia or other psychotic disorder |
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77. Diagnostic Criteria: Schizoid PD
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Pervasive pattern of detachment & restricted range
of emotion. 4 or more of the following: – Neither desires nor enjoys close relationships; prefers solitary activities – Little if any interest in sexual experience – Pleasure in few if any activities – Lacks close friends or confidents other than 1st degree relatives – Indifferent to praise or criticism – Emotional coldness, detachment, or flattened affect |
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78. Diagnostic Criteria: Schizotypal Personality Disorder: DSM-IV features Social-interpersonal deficits + cognitive-perceptual distortions
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5 of 9 symptoms needed to diagnose:
• Ideas of reference • Odd beliefs or magical thinking • Unusual perceptual experiences • Odd thinking or speech • Suspiciousness or paranoid ideation • inappropriate or constricted affect • Odd, eccentric, or peculiar behavior or appearance • Lack of close friends or confidants • Excessive social anxiety (associated with paranoid fears) |
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79. Which PD's are in the "dramatic" cluster?
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1. Anti-social
2. Borderline 3. Histrionic 4. Narcissistic |
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80. What is anti-social PD?
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A PD marked by a general pattern of disregard for and violation of other peoples' rights
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81. What are people with anti-social PD sometimes called?
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Sociopaths or psychopaths
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82. What is necessary for diagnosis of anti-social PD?
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Must be 18 years old
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83. How is antisocial PD related to criminal behavior?
What are some pre-indicators? |
Aside from substance abuse, this is the disorder most closely linked to adult criminal behavior
Usually display some pattern of misbehavior before 15 |
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84. What are some characteristics of anti-social PD?
Five symptoms.... |
1. Lie
2. Careless w/ money and fail to pay debt 3. Irritable, aggressive, quick to fight 4. Reckless 5. Lack moral conscience |
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85. What is a psychopathy?
What is it characterized by? Two things... |
Mental disorder, especially when manifested by antisocial behavior
Social Deviance and Interpersonal/Emotional Traits (omitted in DSM) |
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86. What does social deviance include?
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-Impulsive
-Poor behavior controls -Need for excitement -Lack of responsibility -Early behavior problems -Adult anti-social PD |
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87. What is meant by interpersonal/emotional traits?
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-Glib and superficial
-Egocentric and grandiose -Lack of remorse or guilt -Lack of empathy -Deceitful and manipulative -Shallow emotions |
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88. What are the risk factors for anti-social PD?
Six signs... |
1. Anti-social PD in parents
2. Difficult temperament 3. Relative lack of social skills 4. Consequences of past experience in anti-social behavior 5. High thresholds for anxiety/fear 6. Difficulty anticipating negative consequences and shift attention |
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89. What are some statistics w/ anti-social PD?
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-Four times more common in men
-White Americans receive dx more than African Americans -Usually criminal behavior declines after age of 40 -Higher rates of alcoholism and substance abuse -Children w/ conduct disorder and ADHD have higher risk of developing anti-social PD |
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90. How is anti-social PD explained?
What is treatment like? |
Explained by genetics, stress in childhood, and modeling (imitation)
1/4 of people w/ disorder receive treatment, but treatment is usu ineffective |
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91. What is borderline PD?
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A PD characterized by repeated instability in interpersonal relationships, self image, and mood and by impulsive behavior
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92. Diagnostic Criters: Borderline Personality Disorder
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-Features personal interpersonal instability and impulsivity
-5 of 9 symptoms needed to diagnose: • Frantic efforts to avoid real or imagined abandonment • Unstable and intense relationships • Unstable self-image or sense of self • Self-damaging impulsivity in at least 2 areas • Recurrent suicidal or self-mutilating behavior • Affective instability and reactivity • Chronic feelings of emptiness • Inappropriate, intense anger or difficulty controlling anger • Transient, stress-related paranoid ideation or dissociation |
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93. What are some borderline PD statistics?
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-20% of psychatric patients meet criteria
-3 to 5% of general population -3/4 female |
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94. What are some characteristics of borderline PD?
six symptoms.... |
1. Emotions seem to always be in conflict w/ the world
2. Prone to bouts of anger 3. Impulsive, self-destructive 4. Self-injurious 5. Intense, conflict-ridden relationships 6. Dramatic shifts in identity |
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95. What percent of people w/ borderline PD commit suicide? How many succeed?
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70% of people attempt
6 to 10% succeed |
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96. What challenges do therapists face when treating borderline PD?
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1. Clingy dependence
2. Manipulativeness 3. Need of exclusive relationship 4. Issues w/ separation and/or abandonment 5. Extreme devaluation 6. Setting Boundaries |
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97. What are some etiological considerations for borderline PD?
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-Early parent-infant relationship
-Parental neglect -Parental sexual/physical abuse -Family stressors (alcoholism, divorce) |
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98. What is histrionic PD?
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A PD characterized by a pattern of excessive emotionality and attention seeking
*once called hysterical PD |
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99. What are some characteristics of histrionic PD?
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1. "emotionally" charged
2. Lack sense of really are 3. Vain, self-centered, demanding 4. Unable to delay gratification 5. Overreact when something gets in their way for attentions |
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100. What is narcissistic PD?
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A PD marked by a broad pattern of grandiosity, need for admiration, and lack of empathy
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101. What are some characteristics of narcissistic PD?
Six things... |
1. Expect constant admiration and attention
2. Exaggerate achievements and talents 3. Appear arrogant 4. Choosy about friends 5. Make good first impressions 6. 75% are men |
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102. According to the social learning perspective, how is narcissistic PD explained?
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-Parents consistently overrate child's performance
-Parents create an unrealistically high self-image for the child by being too positive |
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103. How is treatment for narcissistic PD?
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-One of the most difficult to treat
-Usually only get treatment due to some other disorder, most commonly depression |
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104. What are the PD's in the anxious cluster?
three... |
1. Avoidant PD
2. Dependent PD 3. Obsessive-compulsive PD |
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105. What is avoidant PD?
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A PD characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation
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106. What are some characteristics of avoidant PD?
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1. Dread criticism
2. Feel unappealing or inferior 3. Exaggerate difficulties of new situation 4. Few or no close friends but yearn for intimate relationships 5. Feel depressed and lonely |
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107. How is avoidant PD similar to social phobias?
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Both have fear of humiliation and low confidence
*key difference: people with social phobia fear social circumstance while PD fear close relationships |
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108. What are dependent PD?
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A PD characterized by a pattern of clinging and obedience, fear of separation, and an ongoing need to be taken care of
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109. How do dependent and avoidant PD differ in regard to relationships?
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People w/ avoidant PD have problems initiating relationships
People w/ dependent PD have difficulty with separation from relationships |
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110. What other things are people with dependent PD at risk for? Why?
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At risk for depression, anxiety, and eating disorders
Because they feel distressed, lonely, sad, and often dislike themselves |
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111. What is obsessive-compulsive PD?
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A PD marked by such an intense focus on orderliness, perfectionism, and control that the individual loses flexibility, openness, and efficiency
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112. What are characteristics of obsessive-compulsive PD?
Six things... |
1. Fail to grasp point of activity b/c too focused on details/organization
2. Work is behind schedule 3. Set unreasonably high standards 4. Rigid and stubborn 5. Usually white, educated, married, and employed 6. Twice as likely in men |
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113. What is the "Big 5" theory of personality?
|
Basic structure of personality may consist of five "supertraits"
neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness |
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104. What are some problems of validity with diagnosing personality disorders?
Four things... |
1. Unclear boundaries with normality
2. Overlap among PD (lowers reliability too) 3. Overlap with Axis I categories 4. Impoverished knowledge base |
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105. What is the chance of relative having a PD if proband is diagnosed as Schizotypal?
(schizophrenia, mood disorder, no dx) |
Schizophrenia: 6.9
Mood Disorder: 2.3 No DX: 1.4 |
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106. What is the chance of relative having a PD if proband is diagnosed as Paranoid?
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Schizophrenia: 1.4
Mood Disorder: 0.6 No DX: .4 |
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107. What is the chance of relative having a PD if proband is diagnosed as Avoidant?
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Schizophrenia: 2.1
Mood Disorder: 0.6 No DX: 0.2 |
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108. What is a proband?
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the first affected family member who seeks medical attention for a genetic disorder
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109. Which AXIS 1 disorders are each of the "odd" PD's similar to?
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Paranoid: Schizophrenia; Delusional Disorder
Schizoid: Schizophrenia Schizotypal: Schizophrenia; Delusional Disorder |
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110. Which AXIS 1 disorders are each of the "dramatic" PD's similar to?
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Antisocial: Conduct Disorder
Borderline: Mood Disorders Histrionic: Somatoform Disorders; Mood Disorders Narcissistic: Cyclothymic Disorder |
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111. Which AXIS I disorders are the "anxious/fearful" PD's similar to?
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Avoidant: Social Phobia
Dependent: Separation-Anxiety Disorder; Dysthymic Disorder Obsessive-Compulsive: Obsessive-compulsive anxiety disorder |
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112. What is an impulse-control disorder?
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-Fail to resist impulse, drive, or temptation that is harmful
-Increasing tension proceeds act, followed by relief and possibly (not in all) guilt |
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113. What are some examples of impulse-control disorders?
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Pyromania
Kleptomania Intermittent Explosive Disorder Pathological Gambling |
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114. Which PD's are high for Neuroticism? Which PD is low for it
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HIGH:
Schizotypal, Borderline, Narcissistic, Histrionic, Dependent, Avoidant, Obsessive LOW: Antisocial |
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115. Which PD's are high for Extroversion? Which PD's are low for it?
|
HIGH:
Borderline, Narcissistic, Histrionic, & Dependent LOW: Paranoid, Schizotypal, Schizoid, Avoidant, Obsessive |
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116. Which PD's are high for Openness to experiences? Which PD
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Schizotypal
Histrionic |
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117. Which PD's are low for openness?
|
Paranoid
Obsessive |
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118. Which PD's are high for Agreeableness?
|
Dependent
|
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119. Which PD's are low for Agreeableness?
|
Paranoid
Borderline Narcissistic Antisocial |
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120. Which PD's are high for Conscientiousness and which are low?
|
HIGH:
Narcissistic & Obsessive LOW: Borderline, Histrionic, & Antisocial |
|
121. What are the two categories of mood disorders? What are subcategories of each?
|
1. Unipolar
-Major Depression -Dysthymia 2. Manic-Depressive -Bipolar -Cyclothymia |
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122. What are mood disorders?
|
Periods of time in which normal mood variation is replaced by prolonged depression or mania and associated symptoms
|
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123. What is depression?
|
A low, sad state marked by significant levels of sadness, lack of energy, low self-worth, guilt, and related symptoms
|
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124. What is unipolar depression?
|
Depression without a history of mania
|
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125. What is the prevalence of unipolar depression? What is chance of recurrence?
What is the sex ratio for unipolar depression? |
6% to 9% prevalence
50% recurrence Sex Ratio -in children 1:1 -in adolescents & adults: 2:1 female |
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126. How does unipolar depression vary with age?
|
It increases in adolescence
It spikes in women in their 35-45 It spikes in men in their 50'2 |
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127. What are the five areas of functioning through which depressive symptoms span?
|
Emotional Symptoms
Motivational Symptoms Behavioral Symptoms Cognitive Symptoms Physical Symptoms |
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128. What are the symptoms of unipolar depression?
(1-5) |
1. Intense sadness, dejection, feelings of emptiness
2. Loss of motivation, paralysis of will 3. Markedly altered activity level 4. Negative view of self & future 5. Increased risk of suicide (50% of suicides assoc w/ depression) |
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129. What are the symptoms of unipolar depression?
(6-11) |
6. Complaints about intelligence and memory
7. Perception of performance decreased 8. Physical complaints 9. Sleep problems 10. Loss of interest in sex 11. Change in appetite |
|
130. What drug problem is often comorbid with depression?
|
Alcohol
-self medication with alcohol leads to increased rates of alcohol abuse -33 to 59% of alcohol abusers become depressed -increased family incidence of alcohol and depressive disorder |
|
131. What is the criteria for diagnosing major depressive episode?
|
Period marked by at least five symptoms of depression lasting for two weeks or more
|
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132. What are the symptoms of a major depressive episode?
|
1. Depressed mood, most of the day nearly every day
2. Markedly diminished interest in all activities 3. Significant weight loss 4. Insomnia/hypersomnia 5. Psychomotor agitation or retardation 6. Fatigue/loss of energy 7. Extreme feelings of worthlessness/guilt 8. Diminished ability to concentrate/think 9. Recurrent thoughts of death or suicide |
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133. What is major depressive disorder (MDD)?
|
A severe pattern of depression that is disabling and is not caused by such factors as drugs or a general medical condition
|
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134. What is the criteria for diagnosing major depressive disorder?
|
Experience a major depressive episode without having any history of mania
|
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135. What does it mean to categorize MDD as recurrent? seasonal? catatonic? postpartum? melancholic?
|
1. Recurrent if it has been preceded by previous episode
2. Seasonal, changes w/ seasons 3. Catatonic, marked by either immobility or excessive activity 4. Postpartum, w/in 4 wks of giving birth 5. Melancholic, almost totally unaffected by pleasurable events |
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136. What is dysthymic disorder?
|
A mood disorder that is similar to but longer-lasting and less disabling than a major depressive disorder
|
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137. What are the symptoms of dysthymia?
Seven symptoms... |
1. Chronically depressed, usually for years
2. Problems eating 3. Problems sleeping 4. Tiredness 5. Difficulty concentrating 6. Low opinion of oneself 7. Feelings of hopelessness |
|
138. What is the DSM criteria for diagnosing dysthymic disorder?
Four things... |
1. Depressed mood most of the day, more days than not
2. 2+ yr duration w/ symptoms not absent for more than 2 months 3. No hx of manic or hypomanic episode 4. Significant distress or impairment |
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139. What does "double depression" mean?
|
When dysthymic disorder leads to major depressive disorder, the sequence is called double depression
|
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140. What is exogenous (reactive) depression?
|
Depression that follows clear-cut stressful events
|
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141. What is endogenous depression?
|
Depression that seems to be a response to internal factors
|
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142. What are family pedigree studies? What have they found for depression?
|
Family pedigree studies select people with unipolar depression as probands, examine their relatives, and see whether depression also afflicts other members
*20% of relatives are depressed |
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143. What is a proband?
|
A proband is the person who is the focus of a genetic study
|
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144. What have twin studies revealed about depression?
|
MZ twins: 46% other twin would develop unipolar depression
DZ twins: 20% other twin wold develop unipolar depression |
|
145. What is seasonal affective disorder?
|
Seasonal pattern that onsets in late fall and winter due to increase secretion of melatonin when nights grow longer and longer
|
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146. What is an adjustment disorder?
|
Development of behavioral or emotional symptoms in response to an identifiable stressor within 3 months of occurence
*symptoms are clinically significant |
|
147. What must be ruled out before diagnosing adjustment disorder?
|
Not bereavement or another Axis I disorder
|
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148. What is acute adjustment disorder?
What is chronic adjustment disorder? |
Acute: limit of 6 months
Chronic: greater than 6 months |
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149. What are some risks for depression?
(1-6) |
1. Marital status (separated or divorced 6.3%)
2. Sex of person (female) 3. Pile-up of stressful life events in a short time 4. Family hx of depression 5. Young kid w/ depressed parent 6. Lose parent prior to age 11 |
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150. What are some risks for depression?
|
7. Poor social skills
8. Neuroticism 9. Negative schemas 10. Prior episodes (with repeated episodes, "triggers" become less important) |
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151. Low activity of what two neurotransmitters have been linked to unipolar depression?
|
norepinephrine (catecholamine) and serotonin (indolamine)
|
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152. In depressed people, what gene has been seen to have abnormalities? What does this gene do?
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Abnormality of 5-HTT gene
Gene is responsible for the brain's transportation of serotonin |
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153. Where are the cell bodies of norepinephrine and serotonin located?
Where do their axons extend to? |
Norepinephrine: locus coerulus and lateral tegmental aread
Serotonin: raphe nuclei Axons extend to limibic system and areas involved in emotional control |
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154. Serotonin is believed to possibly be a neuromodulator, what is a neuromodulator?
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A chemical whose primary function is to increase or decrease the activity of other key neurotransmitters
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155. How is cortisol linked to unipolar depression?
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People with unipolar depression have abnormal levels of cortisol (hormone released by adrenal gland during stress)
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156. What is the psychodynamic view for the cause of depression?
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Series of unconscious processes is set in motion when a loved on dies
Unable to accept the loss so mourners regress to the oral stage |
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157. What is a symbolic loss?
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According to Freudian theory, the loss of a valued object which is unconsciously interpreted as the loss of a loved one (aka imagined loss)
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158. According to behavioral perspective, what three factors lead to a vicious cycle that maintains depression?
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1. Low rate of behavioral output
2. Deficiency in social skills 3. Person is not getting enough positive reinforcement from the environment |
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159. What are the two cognitive views on causes for depression?
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1. Theory of negative thinking
2. Theory of learned helplessness |
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160. In the theory of negative thinking, what four things combine to produce unipolar depression?
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1. Maladaptive thinking
2. Cognitive triad 3. Errors in thinking 4. Automatic thoughts |
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161. What are maladaptive attitudes?
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Attitudes such as "If I fail others will feel repelled by me" that result from own experience, family relations, and judgments from people around
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162. What is a cognitive triad?
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The forms of negative thinking that lead to people feeling depressed. The triad consists of a negative view of one's experiences, oneself, and the future
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163. When people make errors in thinking, there are five common types what are they?
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1. Selective abstraction (beat self up over missing one question on an exam)
2. Magnification and minimization (magnify negative and minimize positive events) 3. Personalizaton (it rained b/c I took the day off) 4. Maladaptive attitudes 5. Overgeneralization (I don't know the answer so I'm stupid) |
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164. What are automatic thoughts?
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Numerous unpleasant thoughts that help to cause or maintain depression, anxiety, or other forms of psychological dysfunction
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165. How do automatic thoughts produce feedback?
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The cognitive processes generate new symptoms which increase the 'evidence' of the depressed person's misery and failure
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166. What is learned helplessness?
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The perception, based on past experiences, that one has no control over one's reinforcement and that they themselves are responsible for this helpless state
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167. What is the attribution helplessness theory?
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When people view events as beyond their control, they ask themselves why this is so and attribute to either internal or external causes that may be global or stable
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168. What attributions will cause a person to feel helpless to prevent future negative outcomes and possibly experience depression?
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Attribute present lack of control to some internal cause that is both stable and global
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169. What is dichotomous thinking?
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Form of all or nothing thinking that depressed people may exhibit
For example believing any grade below an A is terrible |
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170. What is interpersonal psychotherapy?
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A treatment for unipolar depression that is based on the belief that clarifying and changing one's interpersonal problems will help lead to recovery
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171. What are interpersonal losses?
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The loss of an important loved one causing a depressed person to experience a grief reaction
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172. What is an interpersonal role transition?
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Depressed people may experience interpersonal role transition brought about by major life changes such as divorce or birth of a child
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173. What are interpersonal deficits?
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Some depressed people display interpersonal deficits such as extreme shyness or social awkwardness which prevent them from having intimate relationship
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174. What is electroconvulsive shock therapy?
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A treatment of last resort for those with severe depression or those not responding to other treatments where an electrical current is sent through the brain causing a brain seizure or convulstions
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175. What are convulsions?
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severe body spasms from ECT
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176. What is insulin coma therapy?
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When large doses of insulin were given to patients suffering from psychosis to produce the desired effect of brain seizures (they were very dangerous and sometimes resulted in death)
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177. What is the effectiveness of ECT?
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60 to 70% improvement in severe cases of depression
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178. What are MAO inhibitors?
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Monoamine oxidase inhibitors are anti-depressant drugs that prevent the action of the enzyme monoamine oxidase which breaks down neuroepinephrine
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179. People taking MAO inhibitors cannot eat food containing what chemical? Why?
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Tyramine (in cheeses, bananas, certain wines)
They will experience a dangerous rise in blood pressure if eat it |
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180. What are the three classes of anti-depressant drugs?
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1. MAO inhibitors
2. Tricyclics 3. Second-generation (SSRI) |
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181. What are tricyclic anti-depressants?
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Drugs such as imipramine that have three rings in their molecular structure
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182. What was the original purpose of imipramine? What did it actually do?
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Originally hope to combat schizophrenia
Found out it relieved unipolar depression in many people |
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183. How long must tricyclics be taken before seeing improvement?
What happens if you stop taking them once you feel relief? |
Take at least 10 days
If stop taking immediately, run a risk of relapsing within a year so continue taking drug for 5 or more months after feeling depressed free |
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184. How do tricyclics and most second-generation anti-depressant work?
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The block the re-uptake of norepinephrine or serotonin thus increasing the activity of the neurotransmitter
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185. Why does it take 10 days for tricyclics to work?
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When ingested they may possibly slow down the activity of the neurons that use norepinephrine and serotonin initially even though they immediately correct for the re-uptake mechanism
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186. Which are given more MAO inhibitors or tricyclics? Why?
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Tricyclics are prescribed more b/c there is no restriction on diet and usually people show higher rates of improvement when taking tricyclics
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187. What are side effects of MAO inhibitors?
Four symptoms... |
1. High blood pressure, stroke, death (due to tyramine ingestion)
2. Anti-cholinergic symptoms, less severe than with tricyclics 3. Weight gain 4. Overdose |
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188. What are possible side effects of tricyclics?
Three things.... |
1. Anti-cholinergic side effects
2. Weight gain 3. Overdose *dizziness, confusion, delusions, hallucinations, rapid heart rate, seizures |
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189. What are anti-cholingeric side effects?
Four symptoms... |
1. Dry mouth
2. Constipation 3. Urinary retention 4. Cardiac problems (orthostatic hypotension, ischemia) |
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190. What are the second-generation selective serotonin re-uptake inhibitors (SSRIs)
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Anti-depressant drugs that increase serotonin activity specifically without affecting other neurotransmitters
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191. What are examples of SSRIs?
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Fluoxetine (Prozac)
Paroxetine (Prozac) Sertraline (Zoloft) |
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192. What are the advantages of SSRIs?
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1. Effectiveness and speed in on par with tricyclics
2. Harder to overdose on them 3. Don't pose dietary risks 4. Don't produce some of the unpleasant side effects (dry mouth and constipation) that tricyclics do |
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193. What are possible side effects of SSRIs
Seven symptoms... |
1. Nausea
2. Loose bowel movements 3. Headache 4. Insomnia 5. Sexual dysfunction 6. Weight gain (rare) 7. Increase suicidal thoughts in adolescents |
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194. What are the most effective treatments for major depressive disorder?
Three treatments.... |
1. Cognitive or interpersonal psychotherapy (55%)
2. Anti-depressant drugs (65%) 3. ECT (60%) |
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195. What are the most effective treatments for dysthymic disorder?
Two treatments.... |
1. Cognitive or interpersonal psychotherapy
2. Anti-depressant drugs *both about 60% |
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196. What is efficacy of behavioral in mild depression?
What is efficacy of placebo? |
80%
30% |
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197. How does gender affect suicide attempt and "success"?
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Twice as many women try it
Twice as many men "succeed" |
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198. What are some general facts about suicide?
Three things... |
1. Few attempt w/o warning
2. 13 of 100,000 deaths in US 3. 15% of clinically depressed will commit suicide |
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199. What is a parasuicide?
How do parasuicider act? (Three things) |
A suicide that does not result in death
Act: -impulsive -make sure of rescue -used methods that are slow to work or completely ineffective |
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200. What is a death seeker?
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A person who clearly intends to end his or her life at the time of suicide attempt
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201. What is a death initiator?
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A person who attempts suicide believing that the process of death is already under way and that he or she is simply quickening the process
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202. What is anomic suicide?
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Suicide committed by individuals whose social environment fails to provide stability thus leaving them w/o a sense of belonging
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203. What is bipolar disorder?
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A disorder marked by alternating or intermixed periods of mania and depression
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204. What is mania?
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A state or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking
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205. What is a manic episode?
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A period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week during which time at least 3 symptoms of mania
*episode may include delusions or hallucinations |
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206. What is a hypomanic episode?
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When the symptoms of mania are less sever causing little impairment
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207. What is characteristic of bipolar I disorder?
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Have full manic and major depressive episodes causing significant distress
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208. What are characteristics of bipolar I disorder?
six things... |
1. Onset bwt 28-33 yrs
2. 1% prevalence 3. No difference in sex ration 4. First episode equally likely to be manic or depressive 5. Manic phase is 2-3 mo and depressive is 3+ mo 6. Course is recurrent (90% w/ multiple episodes) |
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209. What is bipolar II disorder?
|
Hypomanic episodes alternate with major depressive episodes (no manic episodes)
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210. What is rapid cycling?
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Experience four or more episodes of depression and mania or hypomania within a year and there is no intervening normal mood or intervening normal mood for max of 2 weeks
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211. What are risk factors for rapid cycling? What gender is more prone to it?
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Hypothryoidism is a risk factor
More common in women |
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212. What is schizoaffective disorder?
|
Uninterrupted period of illness that includes major depression or manic or mixed episodes w/ positive or negative symptoms of schizophrenia
Hallucination/delusions over 2 wks in asbence of depressed or manic mood and depressed or manic mood is present for much of active & residual period |
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213. What is cyclothymic disorder?
|
A disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms
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214. What are three risk factors for recurrence of manic episodes?
|
1. Younger age at first manic episode
2. Lower stress level of event associated w/ first episode 3. Close family members who have any DSM-IV disorder |
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215. Which disorder(s) presents with similar characteristics to BPD?
What do they share? |
Psychotic disorders (schizophrenia)
Common Symptoms: 1. delusions of grandiosity & persecution 2. Irritability 3. Agitation 4. Catatonic symptoms |
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216. What distinguishes psychotic disorders from BPD?
|
Those with psychotic disorders experience psychosis w/o mood symptoms
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217. How do neurotransmitters relate to bipolar disorder?
|
Mania is associated with high norepinephrine levels and 5-HT is decreased in mania
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218. What is the "permissive theory" of mood disorders?
|
Low 5-HT is a stage setter that is followed by high norepinephrine leading to mania followed by low norepinephrine leading to depression
|
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219. What is the normal distribution of sodium ions in a cell at rest?
|
Na+ ions are on the outer side of the membrane until neuron is stimulated to open Na+ channels and let it in
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220. How has Na+ been linked to bipolar disorder?
|
Persons with BPD have a Na+ dysfunction in that there is improper transport of Na+ between the outside and inside of the neuron's membrane
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221. What have family studies revealed about bipolar disorder?
|
Average risk of 8% in 1st-degree relatives and bipolar probands' relatives are at increased risk (11%) for MDD
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222. What drug is used to treat bipolar disorder?
What does this drug? |
Lithium
It reduces norepinephrine levels and thus its effectiveness is in treating mania |
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223. What is Lithium's mode of operation?
|
Lithium may affect 2nd messenger systems in certain neurons and in doing so may correct the neuron abnormalities from the previous neuron and the actual firing of the neuron
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224. In short what three things does lithium possibly do?
|
1. Alter synaptic activity in neurons
2. Effect second messengers 3. Alter the activity of Na+ ions |
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225. What are second messengers?
|
Chemical changes within a neuron just after the neuron receives a neurotransmitter message and just before it responds (firing of neuron)
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226. What is the effectiveness of Lithium?
|
Improvement rates of patient w/ bipolar range upward from 60%
Prophylatic effect: 40-60% avoid recurrence while taking lithium Lithium also alleviates depressive episodes of bipolar disorder |
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227. How has melatonin been linked to depression?
|
The hormone is released in the dark and plays a role in seasonal affective disorder
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